Billing insurance on Headway

Updated

To bill insurance through Headway, you must be credentialed on Headway with your client’s insurance plan (in addition to being licensed) in the state where your client is physically located during your session.

Why provider credentialing is important

Every insurance company needs to verify that the healthcare professionals in its network have the adequate education, training, and licensure to care for its members.

Because the insurance plan is agreeing to pay for a portion of their members’ care, it’s important that the plan does its due diligence to understand everything you’ve done to become the expert that you are. It also means its members — a.k.a your current and prospective clients — can trust the care they’ll get from you.

Credentialing vs. licensing

Licensing refers to the process of securing the authority to practice within a state, either through self pay or through insurance. License requirements are determined by individual states and their licensing boards (and approved/passed by their state legislature). Each license typically has certain educational, training, and continuing education requirements to obtain and renew a license. Please check with your state licensing board within each state you desire to practice for specific requirements.

Credentialing refers to the process of verifying the provider's license, education, insurance, and other information to ensure they meet the standards of practice required by an insurance company. Credentialing is required to work with an insurance plan and bill insurance.

Please note: On Headway, we require providers to be credentialed and licensed within each specific state they intend to see Headway clients in. For example, if you are licensed and credentialed on Headway in California, and are also licensed (but not credentialed) in New York, you can only see clients via your California license and credentialing.

 

Beta: Client location

To confirm telehealth sessions, providers will be required to enter the client's location during the session. Your client must be physically located in a state where you are credentialed with their insurance plan on Headway in order to confirm the session.

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We need an address on file to ensure providers are seeing their clients compliantly via telehealth, claims are routed properly, and payments are not impacted.

Managing client locations

To update your client’s virtual session location, visit your Clients list. From there, scroll down to the client, and click New location.

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Alternatively, your client can add a new location directly from their account.

Billing method

Under Billing method on each client's page, we exhibit guidance for every possible state that an appointment could take place. Each practice location that a provider has on file, as well as any virtual session location that a client has, is reflected in this section.

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You can refer to these guidance boxes to understand where you'll be able to see the client.

 

Special cases

Blue Cross and Blue Shield (BCBS) plans

Blue Cross and Blue Shield (BCBS) plans operate on a state by state basis, which means that in order to see a client, your client must be located in their plan's typical service area and you must be credentialed with their specific plan in the state (in the state where they are located).

However, the BlueCard program allows you to see clients through any BCBS plan as long as:

  1. Your client is located outside their plan's typical service area.
  2. You are licensed and credentialed with the local BCBS plan where your client is located during the session.

Example:

  • Provider is credentialed with Anthem BCBS New York, and licensed in NY
  • Client is located in NY for college and is insured with a BCBS NC BlueCard plan
  • Provider can see this client via BlueCard, as long as they’re located in NY at the time of the appointment

Virtual networks

Opting into a virtual network allows you to see patients with BCBS plans outside of their typical service area.

For instance, if you are licensed in Texas, opting into the BCBS Massachusetts virtual network would allow you to see BCBS MA patients in Texas, even if you aren't credentialed with the local BCBS Texas plan.

Another example:

  • Provider is credentialed with BCBS MA in TX via the BCBS MA virtual network.
  • Provider can only see clients insured with BCBS MA that are located in TX at the time of the appointment as long as they have a TX license.

 

Frequently asked questions

What if my client who I see through insurance commutes to a different state to receive care?

Regardless of where your client lives, or your location during the session, you can bill sessions as long as your client is physically located (during the session) in a state where you are licensed and credentialed on Headway.

 

What if my client I’ve been seeing through insurance goes on vacation?

To conduct a session, you must hold a license in the state where your client is located at the time of the session. If you are not licensed in that state, you are prohibited from practicing and must adhere to local jurisdictional rules and laws. Some states have temporary practice laws to support existing provider-patient relationships. This allows a provider to practice for a limited time in another state their patient is visiting. Clinicians should consult the respective state's licensing board to confirm if this is permissible and to understand the specific conditions under which they may temporarily practice. 

In emergency situations, clinicians may treat their clients on a case-by-case basis through Headway. Such sessions require comprehensive documentation detailing the crisis and its resolution and must be billed as a crisis session. In these cases, please ensure to get and document the exact address of the client at the time of the crisis session.

 

What if my client I’ve been seeing through insurance moves?

If this is an ongoing situation, you must get licensed and credentialed in your client’s new state to continue seeing them on Headway, or refer them to a new provider.

To continue seeing that client and billing their sessions through insurance via Headway, you must have a license and be credentialed in the new state. 

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